A comprehensive review of neonatal respiratory diseases: Pathophysiology, diagnosis, management, advanced techniques and prevention

Neonatal respiratory diseases are important causes of morbidity and admission to neonatal intensive care units, particularly among preterm and low-birth-weight infants. These disorders develop when the transition from fetal fluid-filled lungs to independent air breathing is impaired or when immature pulmonary, vascular, infectious, or structural conditions interfere with normal gas exchange. Common neonatal respiratory disorders include respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, neonatal pneumonia, persistent pulmonary hypertension of the newborn, pneumothorax, bronchopulmonary dysplasia, and apnea of prematurity. Fetal lung development progresses through embryonic, pseudoglandular, canalicular, saccular, and alveolar stages, and interruption of these processes may result in pulmonary hypoplasia and respiratory dysfunction. Clinical manifestations include tachypnea, grunting, nasal flaring, chest retractions, cyanosis, apnea, and increasing oxygen requirements. Diagnosis is based on clinical assessment supported by pulse oximetry, blood gas analysis, laboratory investigations, chest radiography, echocardiography, and lung ultrasound. Management depends on gestational age, underlying cause, disease severity, and oxygenation status. Current treatment emphasizes early recognition, controlled oxygen therapy, non-invasive respiratory support, surfactant therapy, and lung-protective ventilation while minimizing ventilator-induced lung injury. Advanced approaches include CPAP, non-invasive ventilation, lung ultrasound, volume-targeted ventilation, high-frequency ventilation, and selected use of inhaled nitric oxide. Future neonatal respiratory care is expected to become increasingly personalized through improved monitoring, ultrasound-guided treatment, and artificial intelligence-assisted prediction. Prevention includes antenatal corticosteroids, appropriate delivery-room care, infection control, and gentle respiratory support to improve neonatal outcomes.